ARRS Role Spotlight: Marie Jordan
We often do case studies surrounding our ARRS roles in order to better understand the many ways they engage with our patients and how we can improve on the services we offer.
We plan to share some of these studies with our patients to help them better understand our ARRS roles, the many services we offer, and how they can benefit from them.
This month, we would like to shine a spotlight on our Occupational Therapist, Marie Jordan and all the amazing work she’s been doing.
Patient Case Study: Overcoming Mobility Issues
Introduction
This presentation explores the case of a male patient aged 75 living with depression and diverticular disease.
This patient was referred to the PCN’s occupational therapy service due to difficulties managing his activities of daily living whilst awaiting Neurology input for an unexplained reduction in dexterity in both hands.
Both the patient and his wife were struggling.
First steps
A case review of the records demonstrated a complex family dynamic, with issues apparent between the patient and his wife, and between the patient's daughter and his wife.
To assess him formally, a visit was required; however, based on safeguarding Marie and the patient, a chaperone (another ARRS role) was required to attend the visit.
During this visit, Marie performed the following.
- A review of mobility
- A review of transfers (sit to stand, stand to toilet, stand to bed, sit to lie)
- A review of his positioning (holding his arm close to his body -protectively)
- A review of the patient’s range of movement
How did Marie review movement and strength?
- Arm raises - Good
- Arm abduction - Good
- Arm adduction – Good
- Wrist flexion and extension – Good
- Wrist pronation and supination – Good
- Finger opposition – Difficult for the patient
- Stop Marie pushing hands backwards – Slightly decreased (right hand side)
- Stop Marie pulling his hands forward – Slightly decreased (right hand side)
During the course of this assessment, it was discovered that the patient had not been using his right limb on a day-to-day basis, preventing him from completing his personal care needs. This lack of action has significantly contributed to the decline in mobility of the limb. When a limb is not used, it not only experiences muscle deterioration, but the neural pathways associated with that limb also become less maintained over time. Marie has compared this process to a road: if a road is used regularly, it stays well cared for, smooth, and has well-maintained surfaces and lights. Conversely, if a road is left unused and falls into disrepair, its surface becomes full of potholes, the lights are not maintained, and navigating it becomes increasingly difficult.
Recommendations
- To start using the right upper limb in ALL activities – If you don’t use your muscles, you lose your muscles.
- As he was having difficulty lifting his right arm to his mouth, it was advised that he use his left arm to support the movement of his right arm to tell the brain that his arm is still functional. In addition to this, sensory methods can be used to prompt the brain, such as by rubbing in moisturising creams. It was recommended that these be done whilst watching TV, for example.
- It was recommended that the patient consciously put his right arm down when standing, walking, etc, instead of having it cradled close to his body.
- Equipment was ordered to support the patient at home.
- Hand putty was also introduced. Please see below a description of this product and how to use it.
Hand Putty
- Being given hand putty is like being given tools from a specialist toolbox to improve strength and functional ability. It requires commitment and ongoing use.
- An open follow-up is available to patients who are having difficulties, want to increase the difficulty, or who need to be reassessed.
- If the putty does not increase strength, it will maintain existing strength and function.
- Patients are risk assessed, educated and safety netted.
The benefits of using hand putty in the community are;
- Enabling the patient to complete personal care through facilitating and strengthening required movements.
- Complete activities of daily living (removing a lid from a bottle, brushing teeth or combing their hair, for example).
- Meal preparation.
More instructions and exercises for using hand putty can be found HERE.
Next Steps
For Patient -
- Commitment to his exercises – this has been reinforced by his Neurologist, who has subsequently made a diagnosis of Parkinson's and commenced medication.
- Seek support where it is required and with the support of Social Care (long-term package of care introduction).
For Marie -
- Follow up with the patient and assess his ability to complete his exercises and the benefits of the equipment which was ordered to support him.
- Patient outcome data collection – qualitative (feedback) and quantitative (functional skills assessment).
Patient Reflection:
"I would like to say a big thank you to occupational therapist Marie Jordan who has made a big difference to my life.
She is very diligent and has gone over and above to help me. She is exceptionally caring and her visits have not only helped me to overcome the physical challenges of MS , but, more importantly, her support has made me feel as though I am not facing those challenges alone.
She is an asset to the Spring Hill team".
To learn more about Marie and how she can help you, please visit the following section of our website.